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Articles from Other Journals

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Dog Ownership and Cardiovascular Health: Results from the Kardiovize 2030 Project. Maugeri A, Medina-Inojosa JR, Kunzova S, Barchitta M, Agodi A, Vinciguerra M, Lopez-Jimenez F. Mayo Clin Proc Innov Qual Outcomes. 2019 Aug 23;3(3):268-275. (9-16-18).

Analysis of Human Performance Deficiencies Associated with Surgical Adverse Events. Suliburk JW, Buck QM, Pirko CJ, Massarweh NN, Barshes NR, Singh H, Rosengart TK. JAMA Netw Open. 2019 Jul 3;2(7):e198067. (8-5-19)

New Drugs: Where Did We Go Wrong and What Can We Do Better? Wieseler B, McGauran N, Kaiser T. BMJ. 2019 Jul 10;366:l4340. (7-20-19)

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Butler CC, Gillespie D, White P, et al. N Engl J Med. 2019 Jul 11;381(2):111-120. (7-12-19)

Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. Subirà C, Hernández G, Vázquez A. et al. JAMA. 2019;321(22):2175-82. (6-11-19)

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis. Seymour CW, Kennedy JN, Wang S, et al. JAMA. 2019 May 19. (5-30-19)

Association of Unrecognized Obstructive Sleep Apnea with Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery. Chan MTV, Wang CY, Seet E, et al. JAMA. 2019 May 14;321(18):1788-98. (5-21-19)

CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea.  Richards KC, Gooneratne N, Dicicco B, et al. J Am Geriatr Soc. 2019 Mar;67(3):558-64. (5-12-19)

Almost Half of Physicians Say EHRs Have Hurt Quality of Care. Frellick M. Medscape. May 01, 2019. (5-2-19)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1. [Epub ahead of print] (4-15-19)

Association of Positive Airway Pressure Prescription with Mortality in Patients with Obesity and Severe Obstructive Sleep Apnea: The Sleep Heart Health Study. Lisan Q, Van Sloten T, Marques Vidal P, Haba Rubio J, Heinzer R, Empana JP. JAMA Otolaryngol Head Neck Surg. 2019 Apr 11. (4-12-19)

Effect of Glucose Improvement on Spirometric Maneuvers in Patients with Type 2 Diabetes: The Sweet Breath Study. Gutiérrez-Carrasquilla L, Sánchez E, Barbé F, et al. Diabetes Care. 2019 Apr;42(4):617-24. (4-12-19)

Whole-Genome Sequencing of Pharmacogenetic Drug Response in Racially Diverse Children with Asthma. Mak ACY, White MJ, Eckalbar WL, et al. Am J Respir Crit Care Med. 2018 Jun 15;197(12):1552-64. (3-26-19)

Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules and Sleep and Alertness in a Duty-Hour Flexibility Trial in Internal Medicine. Silber JH, Bellini LM, Shea JA, et al. N Engl J Med 2019; 380:905-14 and 915-23. (3-7-19)

Factors Associated with High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care: A Systematic Review. Molino CGRC, Leite-Santos NC, Gabriel FC, et al. JAMA Intern Med. 2019 Feb 18. (2-25-19)

Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free from Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. Beitler JR, Sarge T, Banner-Goodspeed VM, et al. JAMA. 2019 Feb 18. [Epub ahead of print] (2-21-19)

Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open. 2019 Feb 1;2(2):e187571. (2-19-19)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1 [Epub ahead of print].  (2-4-19)

A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. Hajek P, Phillips-Waller A, Przulj D, et al. N Engl J Med. 2019 Jan 30. [Epub ahead of print]. (1-31-19)

Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU. Krag M, Marker S, Perner A, et al. N Engl J Med. 2018 Dec 6;379(23):2199-2208. (1-30-19)

Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers. Penn M, Bhatnagar S, Kuy S, Lieberman S, Elnahal S, Clancy C, Shulkin D. JAMA Netw Open. 2019 Jan 4;2(1):e187096. (1-21-19)  

The Importance of Smoking Cessation on Surgical Outcome in Primary Lung Cancer. Fukui M, Suzuki K, Matsunaga T, Oh S, Takamochi K. Ann Thorac Surg. 2019 Jan 2. pii: S0003-4975(18)31871-X. (1-20-19)

FDA Warns About Increased Risk of Ruptures or Tears in the Aorta Blood Vessel With Fluoroquinolone Antibiotics in Certain Patients. US Food and Drug Administration. December 20, 2018. (12/22/18).

Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Jacobs SS, Lederer DJ, Garvey CM, et al. Ann Am Thorac Soc. 2018 Dec;15(12):1369-81. (12-13-18)

FDA Approves First Treatment for Lambert-Eaton Myasthenic Syndrome, A Rare Autoimmune Disorder. FDA News Releast. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm627093.htm (12-4-18)

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients with Undifferentiated Hypotension? Atkinson PR, Milne J, Diegelmann L, et al. Ann Emerg Med. 2018 Oct;72(4):478-89. (11-8-18)

E-cigarette Use and Subsequent Smoking Frequency Among Adolescents. Barrington-Trimis JL, Kong G, Leventhal AM, et al. Pediatrics. November 05, 2018. [Epub ahead of print] (11-5-18)

Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. Magill SS, O'Leary E, Janelle SJ, et al. N Engl J Med. 2018 Nov 1;379(18):1732-1744. (11-1-18)

Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients with Mild Hypertension. Sheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs FDR, McManus RJ. JAMA Intern Med. October 29, 2018. (11-30-18)

Prevalence of Financial Conflicts of Interest Among Authors of Clinical Guidelines Related to High-Revenue Medications. Khan R, Scaffidi MA, Rumman A, Grindal AW, Plener IS, Grover SC. JAMA Intern Med. 2018 Oct 29. and Evaluation of Industry Relationships Among Authors of Clinical Practice Guidelines in Gastroenterology. CombsTR, Scott J, Jorski A, Heavener T, Vassar M. JAMA Intern Med. 2018 Oct 29. (10-30-18).

Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. Hayden FG, Sugaya N, Hirotsu N, et al. N Engl J Med. 2018 Sep 6;379(10):913-23. (10-25-18)

Assessment of Industry Data on Pulmonary and Immunosuppressive Effects of IQOS. Moazed F, Chun L, Matthay MA, Calfee CS, Gotts J.. Tob Control. 2018 Aug 29. pii: tobaccocontrol-2018-054296. [Epub ahead of print] (9-24-18)

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018 Sep 16. [Epub ahead of print] (9-20-18)

Improved Empirical Antibiotic Treatment of Sepsis After an Educational Intervention: The ABISS-Edusepsis Study. Ferrer R, Martínez ML, Gomà G, et al. Crit Care. 2018 Jun 22;22(1):167. (8-31-18).

Effect of Azithromycin on Airflow Decline-Free Survival After Allogeneic Hematopoietic Stem Cell Transplant: The ALLOZITHRO Randomized Clinical Trial. Bergeron A, Chevret S, Granata A, et al. JAMA 2017;318(6):557-566. (8-8-18)

Depression, Antidepressant Use, and Risk of Venous Thromboembolism: Systematic Review and Meta-Analysis Of Published Observational Evidence. Kunutsor SK Seidu S, Khunti K. Ann Med. 2018 Jul 12:1-17. (7-30-18)

Electronic Health Records Associated with Lower Hospital Mortality After Systems Have Time to Mature. Lin SC, Jha AK, Adler-Milstein J. Health Aff (Millwood). 2018 Jul;37(7):1128-1135. (7-12-18)

Sodium Bicarbonate Therapy for Patients with Severe Metabolic Acidaemia in the Intensive Care Unit (BICAR-ICU): A Multicentre, Open-Label, Randomised Controlled, Phase 3 Trial. Jaber S, Paugam C, Futier E, et al. Lancet. 2018 Jun 14. pii: S0140-6736(18)31080-8. (7-6-18)

Combined Analysis of Asthma Safety Trials of Long-Acting β2-Agonists. Busse WW, Bateman ED, Caplan AL, Kelly HW, O'Byrne PM, Rabe KF, Chinchilli VM. N Engl J Med. 2018 Jun 28;378(26):2497-2505. (7-5-18)

Continuity of Care with Doctors-A Matter of Life and Death? A Systematic Review of Continuity of Care and Mortality. Pereira Gray D, Sidaway-Lee K, White E, Thorne A, Evans PH. BMJ Open. 2018 Jun 28;8(6):e021161. (7-3-18)

Minimally Invasive Lung Cancer Surgery Performed by Thoracic Surgeons as Effective as Thoracotomy. Boffa DJ, Kosinski AS, Furnary AP, et al. J Clin Oncol. 2018 May 23:JCO2018778977. [Epub ahead of print] (6-30-18)

Serotonergic Antidepressant Use and Morbidity and Mortality Among Older Adults with COPD. Vozoris NT, Wang X, Austin PC, et al. Eur Respir J  2018 Jun 26. [Epub ahead of print] (6-27-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018 Jun 12. [Epub ahead of print] (6-17-18)

Effects on Abstinence of Nicotine Patch Treatment Before Quitting Smoking: Parallel, Two Arm, Pragmatic Randomised Trial. The preloading investigators. BMJ. 2018 Jun 13;361:k2164. (6-15-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018. June 11, 2018. [Epub ahead of print] (6-12-18)

Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, Ong MK, Atkins D, Schectman G, Asch SM. Ann Intern Med. 2018 Jun 5. [Epub ahead of print] (6-7-18)

Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education: A Randomized Clinical Trial. Finn KM, Metlay JP, Chang Y, Nagarur A, Yang S, Landrigan CP, Iyasere C.JAMA Intern Med. 2018 Jun 4 [Epub ahead of print]. (6-6-18)

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. Sparano JA, Gray RJ, Makower DF, et al. N Engl J Med. 2018; June 3. (6-4-18)

Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients with Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, Cleghorn MR, McGill JW, Cole JB. JAMA. 2018 May 16. (6-1-18)

Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians With Subsequent Opioid Prescribing. Hadland SE, Cerdá M, Li Y, Krieger MS, Marshall BDL. JAMA Int Med 2018; May 14. [Epub ahead of print] (5-14-18)

Low-Dose CT for the Diagnosis of Pneumonia in Elderly Patients: A Prospective, Interventional Cohort Study. Prendki V, Scheffler M, Huttner B, et al. Eur Respir J. 2018 Apr 12. pii: 1702375. [Epub ahead of print] (5-4-18)

Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden. Hellmann MD, Ciuleanu TE, Pluzanski A, et al. N Engl J Med. 2018 Apr 16 [Epub ahead of print] (4-17-18)

Four-gene Pan-African Blood Signature Predicts Progression to Tuberculosis. Suliman S, Thompson E, Sutherland J, et al. Am J Respir Crit Care Med. 2018 Apr 6. [Epub ahead of print] (4-10-18)

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era. Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. Fam Med. 2018 Feb;50(2):91-9. (3-28-18)

Impact of Temporary Methotrexate Discontinuation for 2 Weeks on Immunogenicity of Seasonal Influenza Vaccination in Patients with Rheumatoid Arthritis: A Randomised Clinical Trial. Park JK, Lee YJ, Shin K, Ha YJ, et al.  Ann Rheum Dis. 2018 Mar 23. pii: annrheumdis-2018-213222. (3-27-18)

Quantifying Population-Level Health Benefits and Harms of E-Cigarette Use in the United States. Soneji SS, Sung HY, Primack BA, Pierce JP, Sargent JD. PLoS One. 2018 Mar 14;13(3):e0193328. (3-15-18)

Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. Krebs EE, Gravely A, Nugent S, et al. JAMA. 2018 Mar 6;319(9):872-82. (3-6-18)

Adolescent Exposure to Toxic Volatile Organic Chemicals from E-Cigarettes. Rubinstein ML, Delucchi K, Benowitz NL, et al. Pediatrics. 2018;141(4):e20173557. (3/5/18)

Electronic Cigarette Use and Progression from Experimentation to Established Smoking. Chaffee BW, Watkins SL, Glantz SA. Pediatrics. 2018;141(4):e20173594. (3/5/18)

Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. Christensen CH, Rostron B, Cosgrove C, et al. Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. JAMA Intern Med. 2018 Feb 19. [Epub ahead of print] (2-22-18)

Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. Svanes Ø, Bertelsen RJ, Lygre SH, et al.  Am J Respir Crit Care Med. 2018 Feb 16. [Epub ahead of print] (2-20-18)

Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture. Gonzalez AV, Coulombe J, Ernst P, Suissa S. Chest. 2018;153(2):321-8. (2-15-18)

Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program.  Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, et al. Crit Care Med 2018;46:181-8. (2-8-18) 

Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia. Blackley DJ, Reynolds LE, Short C, Carson R, Storey,E, Halldin,CN, Laney AS. JAMA 2018;319(5):50-1. (2-6-18)

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. Hackshaw A,  Morris JK, Boniface S, Tang JL, Milenković D. BMJ. 2018;360:j5855. (1-27-18)

Comparison of observed harms and expected mortality benefit for persons in the veterans health affairs lung cancer screening demonstration project. Caverly TJ, Fagerlin A, Wiener RS, Slatore CG, Tanner NT, Yun S, Hayward R. JAMA Intern Med. 2018 Jan 22. [Epub ahead of print] (1-22-18)

Risk of thromboembolism in cisplatin versus carboplatin-treated patients with lung cancer. Kim ES, Baran AM, Mondo EL, et al. PLoS One. 2017 Dec 11;12(12):e0189410. (1-8-18)

Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: A nested case-control study. Wang MT, Liou JT, Lin CW, Tsai CL, Wang YH, Hsu YJ, Lai JH. JAMA Intern Med. 2018 Jan 2. [Epub ahead of print] (1-5-18)

Previously selected articles that were thought important but had received little attention were summarized under our “News” section. However, the work of publication (review, DOAJ, doi, social media, etc.) has become too arduous to do justice to these publications. Therefore, we are beginning a new section titled “News from Other Journals” where selected articles are briefly summarized. Important articles that are published in journals commonly read by pulmonologists, intensivists or sleep physicians will not necessarily be reviewed but articles that are in general medicine journals or lower impact journals that might be of interest to the practicing physician are selected. As always, there will be links to the article via CrossRef and/or PubMed.

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Thursday
May302019

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis

Seymour CW, Kennedy JN, Wang S, et al. JAMA. 2019 May 19. [CrossRef] [PubMed]

Sepsis is a heterogeneous syndrome. Identification of distinct clinical phenotypes may allow more precise therapy and improve care. The authors derived sepsis phenotypes from 20,189 total who met Sepsis-3 criteria within 6 hours of hospital presentation at 12 Pennsylvania hospitals (2010-2012) using consensus k means clustering applied to 29 variables. Reproducibility and correlation with biological parameters and clinical outcomes were assessed in a second database (2013-2014; n = 43 086 total patients), in a prospective cohort study of sepsis due to pneumonia. Of the 4 derived phenotypes, the α phenotype was the most common (n = 6625; 33%) and included patients with the lowest administration of a vasopressor; in the β phenotype (n = 5512; 27%), patients were older and had more chronic illness and renal dysfunction; in the γ phenotype (n = 5385; 27%), patients had more inflammation and pulmonary dysfunction; and in the δ phenotype (n = 2667; 13%), patients had more liver dysfunction and septic shock. Phenotype distributions were similar in the validation cohort. The 28-day and 365-day mortality were highest among the δ phenotype vs the other 3 phenotypes (P < .001). This study shows that older sicker patients with sepsis are more likely to die. The authors conclude that further research is needed to determine the utility of these phenotypes in clinical care.  

Tuesday
May212019

Association of Unrecognized Obstructive Sleep Apnea with Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery

Chan MTV, Wang CY, Seet E, et al. JAMA. 2019 May 14;321(18):1788-98. [CrossRef] [PubMed]

Unrecognized obstructive sleep apnea increases cardiovascular risks in the general population, but whether obstructive sleep apnea poses a similar risk in the perioperative period remains uncertain. This prospective cohort study enrolled adult at-risk patients without prior diagnosis of sleep apnea and undergoing major noncardiac surgery from 8 hospitals in 5 countries between January 2012 and July 2017, with follow-up until August 2017. The primary outcome was a composite of myocardial injury, cardiac death, heart failure, thromboembolism, atrial fibrillation, and stroke within 30 days of surgery. Among a total of 1364 patients recruited for the study, 1218 patients (mean age, 67 [SD, 9] years; 40.2% women) were included in the analyses. Obstructive sleep apnea was classified as mild (respiratory event index [REI] 5-14.9 events/h), moderate (REI 15-30), and severe (REI >30), based on preoperative portable sleep monitoring. At 30 days after surgery, rates of the primary outcome were 30.1% (41/136) for patients with severe OSA, 22.1% (52/235) for patients with moderate OSA, 19.0% (86/452) for patients with mild OSA, and 14.2% (56/395) for patients with no OSA. OSA was associated with higher risk for the primary outcome (adjusted hazard ratio [HR], 1.49 [95% CI, 1.19-2.01]; P = .01); however, the association was significant only among patients with severe OSA (adjusted HR, 2.23 [95% CI, 1.49-3.34]; P = .001) and not among those with moderate or mild OSA (P > .05). The mean cumulative duration of oxyhemoglobin desaturation less than 80% during the first 3 postoperative nights in patients with cardiovascular complications (23.1 [95% CI, 15.5-27.7] minutes) was longer than in those without (10.2 [95% CI, 7.8-10.9] minutes) (P < .001). Among at-risk adults undergoing major noncardiac surgery, unrecognized severe obstructive sleep apnea was significantly associated with increased risk of 30-day postoperative cardiovascular complications. Further research would be needed to assess whether interventions can modify this risk.

Sunday
May122019

CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea

Richards KC, Gooneratne N, Dicicco B, et al. J Am Geriatr Soc. 2019 Mar;67(3):558-64. [CrossRef] [PubMed]

Obstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial. Older adults, aged 55 to 89 years, with an apnea-hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI -CPAP), n = 25. The primary cognitive outcome was memory (Hopkins Verbal Learning Test-Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, and Clinical Dementia Rating. Statistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI -CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73-2.62), with a 6-month effect size (ES) of 0.46 and a 1-year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI -CPAP group. The authors conclude that after controlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition and may slow the trajectory of cognitive decline.

Thursday
May022019

Almost Half of Physicians Say EHRs Have Hurt Quality of Care

Frellick M. Medscape. May 01, 2019. Available at: https://www.medscape.com/viewarticle/912340 (accessed 5/2/19)

Recently, Medscape conducted a poll titled “What Are the Pros and Cons of Your EHR?”. There were 273 respondents — 207 physicians and 66 nurses/APRNs. More physicians said that electronic health record (EHR) systems have decreased quality of care (44%) in their primary workplace than increased it (40%). Nurses and advanced practice registered nurses (APRNs) saw more benefit than detriment in EHRs: 42% said they had increased quality of care vs 35% who said they had decreased care quality.

A clue to the cause for the perception of a decrease in quality may be that few physicians or nurses were involved in the decision of which EHR to use in their primary workplace. Among physicians, only 28% had input in choosing the HER and only 2% of physicians, nurses, and APRNs said they had input into the decision and the system they wanted was chosen.

When asked what aspects of EHRs increased quality of care, the top answer among physicians was the ability to locate and review patient information more easily (59%), followed by the ability to electronically subscribe (49%), and portability/access to patient records by all members of the care team (44%). Portability and access by all on the team was the top reason given by nurses/APRNs for increases of care quality (62%), followed by ability to locate and review patient information more easily (60%), and ability to electronically prescribe (46%).

When physicians and nurses/APRNs were asked what aspects of EHRs decrease quality of care, they gave similar weight to these four reasons: added paperwork/charting; entering data during the patient encounter; lack of interoperability with other systems; and system failures or problems. A family medicine physician summarized what many doctors have said the field of medicine has lost in a decade with such a system — the nuances in narratives about the patient. They reduce "fascinating human stories to utterly boring, repetitious templates," he wrote.

The results of the iCOMPARE reported earlier this month suggest that the drift from face-to-face care is continuing with the next generation of physicians. First-year residents spend almost five times more hours on indirect patient care than on face-to-face patient care, and most of that time was spent working with EHRs.

Monday
Apr152019

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial

Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1. [Epub ahead of print] [CrossRef][PubMed]

A vocal minority of researchers have advised against delaying vasopressors in septic shock, arguing that norepinephrine, not intravenous fluid, as the most effective initial treatment to correct the loss of vascular tone ("vasoplegia") from septic shock. The authors conducted a Phase II trial evaluating the hypothesis that early low-dose norepinephrine in adults sepsis with hypotension increases shock control by six hours compared with standard care. This single-center, randomized, double-blind, placebo-controlled clinical trial was conducted at Siriraj Hospital, Bangkok, Thailand and enrolled 310 adults diagnosed with sepsis with hypotension. The patients were randomly divided into two groups: early norepinephrine (n=155) and standard treatment (n=155). The primary outcome was shock control rate (defined as achievement of mean arterial blood pressure >65mmHg, with urine flow >0.5mL/kg/h for 2 consecutive hours, or decreased serum lactate >10% from baseline) by 6 hours after diagnosis. The patients in both groups were well matched in background characteristics and disease severity. Median time from emergency room arrival to norepinephrine administration was significantly shorter in early norepinephrine group (93 vs.192 min; P<0.001). Shock control rate by 6 hours was significantly higher in early norepinephrine group (118/155 [76.1%] vs.75/155 [48.4%]; P<0.001). 28-day mortality was not different between groups: 24/155 (15.5%) in the early norepinephrine group versus 34/155 (21.9%) in the standard treatment group (P=0.15). The early norepinephrine group was associated with lower incidences of cardiogenic pulmonary edema (22/155 [14.4%] vs. 43/155 [27.7%]; P=0.004) and new-onset arrhythmia (17/155 [11%] vs. 31/155 [20%]; P=0.03). The authors conclude that early norepinephrine was significantly associated with increased shock control by 6 hours. A much larger U.S-based trial testing early vasopressors in septic shock (CLOVERS) is currently recruiting, with plans to enroll up to 2,300 patients and an expected completion date of June 2021.